Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: England NLM ID: 101170508 Publication Model: Print Cited Medium: Internet ISSN: 1538-7836 (Electronic) Linking ISSN: 15387836 NLM ISO Abbreviation: J Thromb Haemost Subsets: MEDLINE
    • Publication Information:
      Publication: 2023- : [New York] : Elsevier
      Original Publication: Oxford : Blackwell Pub.
    • Subject Terms:
      Postthrombotic Syndrome/*epidemiology ; Venous Insufficiency/*epidemiology ; Venous Thrombosis/*epidemiology; Adult ; Aged ; Anticoagulants/therapeutic use ; Canada/epidemiology ; Dilatation, Pathologic ; Drug Monitoring/methods ; Europe/epidemiology ; Female ; Humans ; International Normalized Ratio ; Male ; Middle Aged ; Multivariate Analysis ; Obesity/epidemiology ; Odds Ratio ; Postthrombotic Syndrome/diagnosis ; Postthrombotic Syndrome/drug therapy ; Predictive Value of Tests ; Prevalence ; Prognosis ; Prospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; United States/epidemiology ; Veins/pathology ; Venous Thrombosis/diagnosis ; Venous Thrombosis/drug therapy
    • Abstract:
      Background: Post-thrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). Its diagnosis is based on clinical characteristics. However, symptoms and signs of PTS are non-specific, and could result from concomitant primary venous insufficiency (PVI) rather than DVT. This could bias evaluation of PTS.
      Methods: Using data from the REVERSE multicenter study, we assessed risk factors for PTS in patients with a first unprovoked unilateral proximal DVT 5-7 months earlier who were free of clinically significant PVI (defined as absence of moderate or severe venous ectasia in the contralateral leg).
      Results: Among the 328 patients considered, the prevalence of PTS was 27.1%. Obesity (odds ratio [OR] 2.6 [95% confidence interval (CI) 1.5-4.7]), mild contralateral venous ectasia (OR 2.2 [95% CI 1.1-4.3]), poor International Normalized Ratio (INR) control (OR per additional 1% of time with INR < 2 during anticoagulant treatment of 1.018 [95% CI 1.003-1.034]) and the presence of residual venous obstruction on ultrasound (OR 2.1 [95% CI 1.1-3.7]) significantly increased the risk for PTS in multivariable analyses. When we restricted our analysis to patients without any signs, even mild, of contralateral venous insufficiency (n = 244), the prevalence of PTS decreased slightly to 24.6%. Only obesity remained an independent predictor of PTS (OR 2.6 [95% CI 1.3-5.0]). Poor INR control and residual venous obstruction also increased the risk, but the results were no longer statistically significant (OR 1.017 [95% CI 0.999-1.035] and OR 1.7 [95% CI 0.9-3.3], respectively).
      Conclusions: After a first unprovoked proximal DVT, obese patients and patients with even mild PVI constitute a group at increased risk of developing PTS for whom particular attention should be paid with respect to PTS prevention. Careful monitoring of anticoagulant treatment may prevent PTS.
      (© 2012 International Society on Thrombosis and Haemostasis.)
    • Grant Information:
      MOP 64319 Canada Canadian Institutes of Health Research
    • Molecular Sequence:
      ClinicalTrials.gov NCT00261014
    • Accession Number:
      0 (Anticoagulants)
    • Publication Date:
      Date Created: 20130103 Date Completed: 20130830 Latest Revision: 20230829
    • Publication Date:
      20240829
    • Accession Number:
      10.1111/jth.12106
    • Accession Number:
      23279046